Download An Unusual Variation of Axillary Artery: A Case Report

Anatomy Section
DOI: 10.7860/JCDR/2015/11680.5477
Case Report
An Unusual Variation of Axillary Artery:
A Case Report
Aastha1, Anjali Jain2, M. Santhosh Kumar3
ABSTRACT
An unusual unilateral variation was observed in branching pattern and course of branches of the axillary artery of the left upper limb in an
adult male cadaver. The superior thoracic branch of axillary artery had a very unusual course as it passed between the two divisions of the
lateral cord of the brachial plexus and then descended down towards the first two intercostal spaces. A common trunk was seen arising
from the third part of the axillary artery which divided into anterior and posterior circumflex humeral, subscapular and Profunda brachii artery.
The ulnar and radial collaterals arose from the Profunda brachii artery rather than the brachial artery. The knowledge about such variations
becomes essential and of utmost significance in various clinical procedures performed by the vascular surgeons, radiologists and clinical
anatomists. Moreover, the injuries of the brachial plexus are quite common and require exploration and repair. During such repair surgeries
the abnormal arterial branch may be a matter of definite concern if its presence is not kept in mind.
Keywords: Axillary artery, Common subscapular trunk, Superior thoracic artery
CASE REPORT
During the routine dissection of the left upper limb in an adult
male cadaver, variations in branching patterns were noted. The
branching pattern of the axillary artery and the course of the
branches of the axillary artery showed a variation which was
observed in the branches of 1st and 3rd part. There was no variation
in the 2nd part.
FIRST PART: Superior thoracic artery was seen to arise from the
lateral aspect of the 1st part. It coursed between the two divisions
forming the lateral cord of the brachial plexus as shown in [Table/
Fig-1]. It then continued downwards towards the axilla passing
posterior to the cords of the brachial plexus and second part of the
axillary artery and here it divided into two branches. The superior
branch travelled down and entered the first intercostal space
to supply it. The inferior entered the second intercostal space to
supply it.
SECOND PART: The lateral thoracic artery was seen arising from
the inferomedial aspect of the artery and acromiothoracic artery
arose from the anteromedial aspect of the artery. Their branching
pattern did not show any variation.
THIRD PART: A common trunk was seen arising from the inferolateral
aspect of the third part as shown in [Table/Fig-2]. This common
trunk passed between the two roots of the median nerve as seen
in [Table/Fig-1]. It travelled downwards behind the medial root of
the median nerve and the ulnar nerve. Just below its origin, the
radial nerve was seen crossing this common trunk inferomedially.
Approximately 5cm from the origin, the common trunk divided
into various branches- a subscapular artery, anterior circumflex
humeral and a posterior circumflex humeral artery [Table/Fig-2].
The main trunk continued as the Profunda brachii artery which was
seen entering the radial groove along with the radial nerve. Here, it
divided into 3 to 4 branches which supplied the triceps muscle. The
superior ulnar collateral branch was also seen arising from the main
trunk just before it entered the radial groove [Table/Fig-3] .This artery
was seen running with the ulnar nerve till the elbow and ended by
supplying the elbow joint. The inferior ulnar collateral artery arose
from the superior ulnar collateral artery and thereafter took a normal
Journal of Clinical and Diagnostic Research. 2015 Jan, Vol-9(1): AD05-AD07
Superior view- arm extended of left axilla
[Table/Fig-1]: Shows superior thoracic artery and the common trunk. I, II, IIIparts of left axillary artery (AA). STA- superior thoracic artery, AD-anterior division,
PD- posterior division, LC-lateral cord, CT- common trunk, MRMN- medial root
of median nerve, LRMN- lateral root of median nerve, MN- median nerve, PBAprofunda brachii artery, BA- brachial artery
[Table/Fig-2]: Shows the common trunk from the left axillary artery (AA) dividing
into various branches. ATA- acromiothoracic artery, LTA- lateral thoracic artery,
CT- common trunk, ACHA- anterior circumflex humeral artery, PCHA- posterior
circumflex humeral artery, SSA- subscapular artery, PBA- profunda brachii artery,
BA-brachial artery
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Aastha et al., An Unusual Variation of Axillary Artery: A Case Report
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S. No
Author
Year
Findings
1
Venieratos and lolis [8]
2001
Common subscapular trunk from
third part of axillary artery giving
various branches.
2
Saeed et al., [3]
2002
Aberrant subclavian artery and
variant branching pattern of the
axillary artery
3
Samuel et al., [9]
2006
A common trunk from third part of
axillary artery dividing into various
type branches
4
Vijaya Bhaskar [10]
2006
Third part of axillary artery divided
into superficial and deep brachial
arteries, deep divided into various
branches.
5
Ramesh Rao T et al.,
[11]
2008
A common trunk from the third part
which dividing into subscapular,
anterior and posterior circumflex
humoral, profunda brachii arteries
and ulnar collateral arteries on left
side
6
Vasudha et al., [12]
2008
Superior thoracic and collateral
branch from first and no branches
from rest of the axillary artery.
7
Syed Rehan [13]
2010
Thoraco acromial arterie from first
and second part and two posterior
circumflex humoral arteries from the
third part.
8
Kumar N et al., [14]
2014
Profunda brachii artery from 3rd part
of the axillary artery.
Left axilla- anterior view
[Table/Fig-3]: Shows superior ulnar collateral artery arising from the profunda
brachii artery –PBA left side, AA-axillary artery, SUCA-superior ulnar collateral artery,
BA-brachial artery, ACHA-anterior circumflex humeral artery, SSA-suprascapular
artery, MCN- musculocutaneous nerve, BB-biceps brachii muscle
course. The third part itself continued as the brachial artery into
the arm but gave no branches in the arm [Table/Fig-3]. No such
variations were noted in the right upper limb.
DISCUSSION
The Axillary artery, a continuation of the subclavian artery, begins at
the outer border of the first rib. At the inferior border of teres major
it continues as the brachial artery. Pectoralis minor crosses axillary
artery and divides it into three parts which are proximal, posterior
and distal to the muscle [1].
Conventionally, the proximal (first part) gives superior thoracic artery.
The posterior (second part) gives thoraco-acromial and lateral
thoracic arteries. The distal (third part) gives subscapular artery,
anterior and posterior circumflex humeral arteries [1].
It is not uncommon to find variations in the branching pattern of the
axillary artery. Many of its branches may arise by a common trunk or
a branch of the named artery may arise separately [2].The vascular
variations of the region should be well known [3].The course and
branching pattern of the axillary artery vary with race, sex and ethnic
groups [3,4].
To correctly diagnose any underlying pathology in the axilla, it is
very essential to have accurate knowledge of the normal and
variant anatomy of the axillary region. This knowledge becomes
the prerequisite for the subsequent clinical procedures of utmost
significance for the vascular surgeons, radiologists and clinical
anatomists [5]. Angiography is the procedure of choice; however,
the term has been applied to newer vascular imaging techniques
such as CT angiography and MR angiography. Isotope angiography
or Isotope perfusion scanning has also been used for studying
vessels.
Twenty three different types of axillary artery on the basis of the
origins of the branches have been described. There is a greater
tendency in the Negro than in the white persons towards clumping
of the branches and arising in common [6].
The first part of axillary artery in rare cases, give rise to the subscapular
artery or supply branch to the subscapular muscles [7].
Similar other variable patterns of branches from first and third part of
axillary artery have been found in different cases, few of them have
been tabulated in [Table/Fig-4].
In the present study the superior thoracic artery arising from the
lateral aspect of the first part took a very unusual course by passing
between the two divisions of the lateral cord of the brachial plexus.
This type of variation has not been reported earlier. The anterior
circumflex, posterior circumflex and profunda brachii did not arise
from the third part of Axillary artery but rather came from the
common trunk. The ulnar and radial collateral arteries also were
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[Table/Fig-4]: Represents variations of first and third part of axillary artery found in
different studies by different authors
not seen arising from the brachial artery but instead from profunda
brachii artery.
The knowledge of these variations is necessary for the surgeons
considering the frequency of procedures performed in this region.
The increasing use of invasive, diagnostic and interventional
procedures in cardiovascular diseases makes it important that the
type and frequency of vascular variations are well documented
and understood. Branches of the upper limb arteries have been
used for coronary bypass and flaps in reconstructive surgery.
Absence or variations of branches of axillary artery is responsible for
compromised collateral circulation between first part of subclavian
and third part of axillary artery in case of a blockage. A branch of
axillary artery passing between the cords of brachial plexus like
in this case can get compressed between the two roots leading
to no or reduced blood supply to the concerned tissue ultimately
leading to it’s death and necrosis. Moreover brachial plexus injury is
a common condition which requires exploration and repair. During
surgery the abnormal branch may be a definite cause of concern if
its presence is not kept in mind [15,16].
CONCLUSION
Awareness about depth and topographic anatomy of deviations
of axillary artery may possibly serve as a helpful information for
radiologists, plastic surgeons and vascular surgeons. It may help to
prevent diagnostic errors, influence surgical tactics and interventional
procedures and avoid complications during the surgery of the axilla
region like abscess drainage and protection of axillary artery in
breast cancer surgery etc. In our case study we found an unusual
variation of axillary artery which should help our medical fraternity.
REFERENCES
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arterial system. Saudi Med J. 2002;23:208-12.
[4] Yang HJ, Gll YC, Jung WS, Lee HY, Variations of the superficial brachial artery in
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www.jcdr.net
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Aastha et al., An Unusual Variation of Axillary Artery: A Case Report
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PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of Anatomy, Christian Medical College and Hospital, Ludhiana, Punjab, India.
2. Professor and Head, Department of Anatomy, Christian Medical College and Hospital, Ludhiana, Punjab, India.
3. Associate Professor and Head, Department of PMR, Christian Medical College and Hospital, Ludhiana, Punjab, India.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Aastha,
Assistant Professor, Department of Anatomy, Christian Medical College and Hospital, Ludhiana, Punjab-141008, India.
E-mail: [email protected]
Financial OR OTHER COMPETING INTERESTS: None.
Journal of Clinical and Diagnostic Research. 2015 Jan, Vol-9(1): AD05-AD07
Date of Submission: Oct 15, 2014
Date of Peer Review: Nov 08, 2014
Date of Acceptance: Nov 28, 2014
Date of Publishing: Jan 01, 2015
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